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First Aid for Back Pain

What did this patient do wrong?



(Published in Murfreesboro Post April 2010)

A new patient sat in my office a few weeks ago. He was in obvious discomfort as he waited. He related that he had been having back pain for over a month. It started after working in the yard when the first warm weather appeared. He had felt some pain beginning in his back, but he had lived through back pain before so he ignored it and pressed on. He had a lot of yard work to do and he was tough.

As the day progressed, the pain subsided for a while, and then returned. He felt his back muscles tightening up and he was having a hard time straightening up. His wife had some muscle relaxers left over from four years previously, so he opted to take those. He also took extra strength Tylenol.

He continued working on the project until he “got to a quitting point”. He went inside to lie on the floor. After an hour, he found that it was very difficult to get up. He managed to get to the shower and felt a little better from the warm water. He then wrapped a heating pad around his back and sat in his recliner and opened a cold beer. After three more beers and two hours with the heating pad, he went to bed.

He awoke several times during the night. He took the rest of his wife’s left-over medication. The next morning he could barely get out of bed and he could not straighten up. It was Sunday, so he took it easy for the rest of the day. He went to work on Monday after taking two doses of the Tylenol. He took a double dose at lunch and again when he got home. He continued this way for four more weeks. He had some relief at times, but no improvement.

By the time I met him he was having back pain constantly. He could not stand straight. He had gone to a walk-in clinic and the nurse-practitioner had prescribed more muscle relaxers and prescription pain medication. He told me that helped some but the pain came back when the drugs wore off.

Most people will experience disabling lower back pain at some point in their life. By disabling, I don’t mean that you will never recover, but rather that you will be dis-abled from doing your normal activities for a time.

I have treated thousands of patients with spinal problems. Each patient is unique. You may have the exact same symptoms as your neighbor, but the cause for the pain may be entirely different. This is important to understand. This means that the recommendations that you see in any magazine or internet article (including this one) are generalized and will not apply to all cases.

After you read the following recommendations, see how many things the patient did wrong.

1. If you begin to feel back pain that is worsening, STOP what you are doing. Continuing the activity will likely worsen your condition. By continuing to work with a worsening injury, the patient made sure he would not be able to work in the yard again for weeks. Had he stopped and addressed the problem correctly, he may have been able to resume his project the next day.

2. For most episodes of lower back and similar pain, application of COLD therapy will not only ease the pain, but also help prevent swelling that can make recovery more difficult. Application of heat may feel good, but can often make the inflammatory condition worse. It is often a good idea to apply a cold gel pack for fifteen minutes, wait a half-hour, and then repeat.

3. “Movement GOOD – Strain BAD”. When joint ligaments are swollen and muscles are in spasm, it may be helpful to GENTLY and SLOWLY move the affected part through a nice, easy range-of-motion. Gentle movement can help preserve function and lessen the severity of the painful muscle spasm. Don’t do any strenuous activity. For low back pain, gentle stretches may be helpful.

Dr. Mark Kestner